KAREN FLOYD ABDOMINAL PAIN LATEST 2023/2024 100% GRADED A, Exams of Nursing

Download KAREN FLOYD ABDOMINAL PAIN LATEST 2023/2024 100% GRADED A and more Exams Nursing in PDF only on Docsity! 1 Questions –yields 90% How can I help you? My stomach hurts Do you have any other symptoms or concerns we should discuss? I occasionally feel “bloated” although I’m not sure my belly is actually bigger when I feel that way. I…well pass a lot of gas and… even belch a lot compared to other people I know. Sort of embarrassing for a woman you know. Do you think that’s related to all of this? Is your pain affected by what, when, or how much you eat? It seems to be worse with rich foods. I haven’t really noticed it as associated with when or how much. Do you now or have you ever smoked or chewed tobacco? No, I never have. Are you taking any over the counter or herbal medications? I take a multivitamin daily, and acetaminophen from time to time for stress headaches Are you taking any prescription medications? No prescription medications Do you have any allergies? Not that I know of Have you ever been hospitalized? Just for the c-section and the bike accident thing Any previous medical, surgical, or dental procedures? I had a c-section at 27 without any complications. When I was 17, I had a bike accident and had a complicated fracture of my right tibia. They had to fix that with surgery. Can you tell me about any current or past medical problems you have had? I don’t know really what’s important. The only thing besides this stomach problem is that lately I’ve been getting occasional hot flashes and my skin is sort of dry. I also get headaches now and then which isn’t new and that probably isn’t important anyway. Is that the kind of things you want to know? 1 Do you have diarrhea? Occasionally. Sometimes I’d say my bowel movement is loose and watery. Does that count? Is there any blood in your stools or with your bowel movement? Anything red? Not that I have noticed Do you have a problem with constipation? Definitely. For as long as I can recall in my adult life, I have alternating periods of constipation and just the opposite if you know what I mean that lasts several days. When I am constipated, I feel like I cannot get everything out, even after a BM. Have you been having fevers? I don’t think so, can you check that for me How often does this abdominal pain occur? It’s been coming and going for years now. It never really goes away entirely, but then it also doesn’t seem to be getting a lot worse. It’s just there all the time. So frustrating. the EHR 1 1 Tell me about your work I am a manager at a local restaurant. I have very long workdays… I usually work late into the night. Have you had a recent endoscopy, colonoscopy, or biopsy? Uh… No. When and what was the result of your last mammogram? I haven’t had one yet. Too busy. Physical Exam Blood pressure 120/60, normal, normotensive Cognitive Alert and oriented x 4 Pulse 60, regular, normal RR 14, regular, unlabored Temp 98.6 Inspect skin overall Dry skin, otherwise unremarkable 1 Inspect hair color, distribution, thickness Thickness and distribution pattern typical for patient gender and age Inspect nails Nails without ridging, pitting, or peeling Test capillary refill Normal capillary reflow Inspect eyes Normal Inspect face Normal expression. No lesions, scars, or abnormal pigmentation. Ocular motor test Normal Examine pupils R – NR, L – NR Inspect/Palpate Head Normocephalic, atraumatic. No deformities. Facial features symmetric. Temporal arteries non-tender to palpation. Frontal and maxillary sinuses non- tender. Inspect/Palpate scalp No visible scaliness, edema, masses, lumps, deformities, scars, rashes, nevi, or other lesions. Non-tender. Inspect neck No visible scars, deformities, or other lesions. Trachea is midline and freely mobile. Inspect mouth/pharynx Oropharynx not injected, clear mucosa, tonsils without exudate. Tongue pink, symmetrical. No swelling or ulcerations. Smell breath No unusual odor Palpate neck Thyroid firm, an acceptable size for patient gender and age. No nodules palpated. Ask patient to swallow Normal exam. Thyroid moves with swallowing. Palpate all lymph nodes No pathologically enlarged lymph nodes in the cervical, supraclavicular, axillary, or inguinal lymph chains. Lung sounds Normal Heart sounds Normal Visual inspection of the abdomen Abdomen is flat and symmetric with no scars, deformities, striae, or lesions Auscultate abdomen Normal Auscultate femoral/abdominal arteries Done Palpate abdomen Mild tenderness with deep palpation of the lower abdomen on both sides. Percuss abdomen Normal Measure girth Appropriate girth for age and gender Visual inspection of the extremities No swelling or deformity. No cyanosis, clubbing, or edema. Palpate extremities There is no tenderness, muscular resistance, rigidity, or deformity. Visual inspection of the rectal area No visible fissures, induration, or lesions. 1 Monofilament test Normal sensory test Assess gait and stance Normal gait and posture Babinski Normal 1 Assess head rotation against resistance/shoulder elevation Symmetric muscle movement without weakness bilaterally Assess for muscle bulk and tone Normal bulk and tone, no rigidity. Look for involuntary movements None of the following movements: - Fibrillations - Fasciculations - Asterixis - Tics, myoclonus - Dystonia’s - Chorea - Athetosis - Hemiballismus - Nor seizures Test strength Strength 5/5 bilaterally Visual inspection AP chest Chest is symmetrical and the AP diameter is normal. The excursion with respiration is symmetrical and there are no abnormal retractions or use of accessory muscles. No distension, scars, masses, or rashes. Palpate AP chest No tenderness, masses, heaves, thrills, or crepitus Percuss AP chest The anterior lung fields are resonant. The left anterior chest and right lower chest are dull to percussion. The rest of the lung fields are resonant and are not hyper- resonant. MS A P Stomach pain Stabbing/cramping abdominal pain Feels bloated Flatulence worse with rich foods Stress headache C-Section Bike riding accident, right tibia fracture Hot flashes Dry skin Occasional diarrhea Incomplete bowel movements Constipation Pain improved with bowel movements 1 Abdominal swelling Problem statement K.F. is a 45 y/o female that presents with a 10-year history of intermittent chronic lower cramping like abdominal pain that is relieved when she has a bowel movement. She endorses episodes of diarrhea, constipation, and mucus in her stool. She states she works long hours at her job and most days skips meals. She denies any chest pain, worsening of pain with her periods, BRBPR, hematuria, abdominal trauma or increased pain when lifting. PE reveals positive findings of hyperactive bowel sounds and mild tenderness with deep palpation of the lower abdomen on both sides. Rectal exam was unremarkable. DDX – 100%, MNM – 100% Diagnosis Lead Alternate MNM 1 Lactose intolerance X 2 Small intestinal bacterial overgrowth X 1 39 DMT1 X 40 DMT2 X 4 1 Diarrhea, medication associated X 42 Constipation X 43 Tropical sprue X 44 Gastroenteritis X 45 Perforated viscus X 46 Pancreatitis, chronic X 47 Colitis, ischemic X 48 HIV X 49 Somatic symptom disorder X 50 Pancreatic insufficiency X 1 5 1 Parkinson’s X 5 2 MS X 5 3 Anemia X 5 4 AAA X 5 5 Abdominal abscess/infection X 5 6 Cholecystitis, acute X 5 7 Celiac X 5 8 Mesenteric ischemia, chronic X 5 9 Mesenteric ischemia X 6 0 Pancreatitis, acute X 6 1 Colitis, non-infectious X 6 2 Anemia, lead poisoning X 6 3 Hypercalcemia X 6 4 Hyperthyroidism, graves X 6 5 Hyperthyroidism, thyrotoxic crisis X 6 6 Arthritis, IBD associated X 6 7 Abdominal neoplasm X 6 8 Pancreatic cancer X 6 9 Choledocholithiasis X 7 0 Somatostatinoma X 7 1 Gastric ulcer X 7 2 Colonic ulcer X 7 3 DKA X 7 4 Ectopic pregnancy X 7 5 MI, acute X 7 6 Ovarian torsion X 7 8 Nephrolithiasis/kidney calculi X 7 9 Peritonitis X 8 0 Peritonitis, spontaneous (NOS) X 1 8 Splenic rupture X 1 9 CTA, abdomen Nor m al 10 ESR Nor m al 1 1 Sigmoidoscopy Nor m al 1 2 Vitamin B12 Norm 1 al Diagnosi s – 100% https://journals.lww.com/ajg/fulltext/2021/01000/acg_clinical_guideline management_of_irritable.11.aspx htt.ojou https://pubmed.ncbi.nlm.nih.gov/33315591/ Chang, L., Sultan, S., Lembo, A., Verne, G., Smalley, W., Heidelbaugh, J. (2022). AGA clinical practice guideline on the pharmacological management of irritable bowel syndrome with constipation. Gastroenterology, 163(1), 118-136. https://doi.org/10.1053/j.gastro.2022.04.016 Management Plan 1 Irritable bowel syndrome Exercises – yields 94%, but not graded per rubric Hematochezia Mucous in the stool Chronic, pellet, period, pain, urgency, sensation, acute Stress and eating Blood, significant, anorexia, pain False All of the above CBC, CRP, celiac sprue panel